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Case 59
Published in Atul B. Mehta, Keith Gomez, Clinical Haematology, 2017
Variants of CLL include as follows: B-cell CLL (as in this patient) carries a good prognosis (10 or more years).T-cell CLL (Figure 59a) is rare, responds less well to therapy and often affects the skin.Splenic marginal zone lymphoma (SMZL) and lymphoma with villous lymphocytes (SLVL) (Figure 59b), which are often accompanied by a paraprotein and responds well to splenectomy.B-cell prolymphocytic leukaemia is characterised by larger cells with nucleoli (Figure 59c) may evolve in patients with CLL or may appear de novo. The white cell count is usually markedly raised, splenomegaly is common, and response to therapy is often poor.Hairy cell leukaemia (Figure 59d) is usually B-cell but occasionally T-cell type.Follicular lymphoma (Figure 59e) affecting the peripheral blood, which can give rise to a similar appearance.
Specific Therapy for Lymphomas
Published in Tariq I Mughal, John M Goldman, Sabena T Mughal, Understanding Leukemias, Lymphomas, and Myelomas, 2017
Tariq I Mughal, John M Goldman, Sabena T Mughal
Prior to the use of immunotherapy in conjunction with chemotherapy, most patients with follicular lymphoma (grade 1 and 2, which contain the least number of large cells) exhibited a disease course which appeared to be unaltered by various treatments. Although highly responsive to single agent chemotherapy, such as chlorambucil, there were no long-term complete remissions, and no definite progression free survival (PFS) or overall survival (OS) benefit. Many specialists, therefore, simply observe patients carefully and offer no specific therapy. When therapy is indicated, often with the emergence of B symptoms, or increasing disease bulk, single agent chlorambucil has been the historical choice. Combination chemotherapy with anthracyclines, such as CHOP (cyclophosphamide, daunorubicin, vincristine, and prednisone), or without an anthracycline, such as CVP (cyclophosphamide, vincristine, and prednisone), causes a more rapid response and a higher proportion of complete remissions, though the OS of about 8 to 10 years is similar; most remissions last for about three years. Other drug combinations of interest include FMD (fludarabine, mitoxantrone, and dexamethasone), which offers high response rates but are associated with increased risk of potentially serious infections. In some patients treated with FMD, molecular remissions have been observed (loss of the BCL-2 gene rearrangement, which is overexpressed in many patients with follicular lymphoma), but its effect on OS, in the absence of the addition of immunotherapy has not been proven as yet.
Microarrays: Human Disease Detection and Monitoring
Published in Attila Lorincz, Nucleic Acid Testing for Human Disease, 2016
Janet A. Warrington, Thomas B. Broudy
Patients with follicular lymphoma survive from 1 to 20 years after diagnosis. In a research program directed by Louis Staudt at the National Cancer Institute (NCI, Bethesda, Maryland, USA, http://cancernet.nci.nih.gov/), Dave et al. measured gene expression from 191 lymphoma biopsy samples and discovered 2 expression signatures, termed immune response-1 and immune response-2, predictive of disease outcome and prognosis.36 The surprising characteristic is that both signatures predominantly stem from nonmalignant immune cells infiltrating the tumors, not from the cancer cells themselves as may have been expected. A good prognosis signature is affiliated with a mixture of immune cells dominated by T cells, while poor prognosis signature genes are highly expressed by a different group of immune cells that include monocytes (precursors to macrophages) and/or dendritic cells.
Systemic follicular lymphoma in a patient with a history of thyroid eye disease: a case report
Published in Orbit, 2023
Vivian L. Qin, César A. Briceño
There have been a few reports of lymphoma in the orbit presenting in patients with known TED.2–4 In one case series, a 73-year-old female with a history of TED presented with unilateral eye pressure and headaches and was subsequently diagnosed with a B-cell lymphoma causing compressive optic neuropathy.3 In another larger retrospective study, 6 patients out of 369 patients who were diagnosed with periocular lymphoma (5 marginal zone lymphoma, 1 DLBCL) were found to have prior TED.4 The observed prevalence (1.6%) of TED history in periocular lymphoma patients was found to be significantly higher than the predicted prevalence (0.4%) based on population estimates, suggesting a relationship between chronic inflammatory stimulation and subsequent development of lymphoma.4 The median latency from TED diagnosis to periocular lymphoma diagnosis has been reported as 17 years,4 similar to the patient in our case who had TED diagnosed 20 years prior. In contrast to those previous reports, our patient presented with follicular lymphoma, and had systemic disease rather than localized disease on presentation.
Full-length recombinant antibodies from Escherichia coli: production, characterization, effector function (Fc) engineering, and clinical evaluation
Published in mAbs, 2022
Mosunetuzumab (RG7828, Lunsumio®) is a humanized CD3-CD20 T cell-dependent bispecific (TDB) antibody with N297G mutation constructed using the KiH technology and is produced in CHO cells.88,159 This antibody simultaneously targets CD20 on B cells, and CD3 on T cells and redirects T cells to eliminate malignant B cells while avoiding the destruction of already engaged T cells. The safety and efficacy of mosunetuzumab as a single agent, or in combination with other agents, is being evaluated in 16 clinical trials (2 Phase 3, 9 Phase 2, and 5 Phase 1) for the treatment of various CD20-expressing B cell malignancies (follicular lymphoma, non-Hodgkin’s lymphoma, diffuse large B cell lymphoma [DLBCL], chronic lymphocytic leukemia).159,160 Preliminary results for patients with relapsed or refractory follicular lymphoma showed an overall response rate of 68%, with 31 patients (50%) achieving complete response. Based on these encouraging clinical data, Genentech’s marketing authorization application for mosunetuzumab as treatment of (3 L+) for follicular lymphoma in the EU was approved in June 2022 (www.antibodysociety.org/antibody-therapeutics-product-data/ (July 26, 2022)).2 In July 2022, the US FDA has accepted Genentech’s BLA and granted a priority review of mosunetuzumab for the treatment of the same indication.
Core needle biopsy is an inferior tool for diagnosing cervical lymphoma compared to lymph node excision
Published in Acta Oncologica, 2021
Rasmus Krarup Sigaard, Kasper Wennervaldt, Lars Munksgaard, Lise Mette Rahbek Gjerdrum, Preben Homøe
We had a total of nine patients with follicular lymphoma (FL). The CNB revealed the correct lymphoma grade in two and different grades in five. There would not be a clinically relevant consequence in three of these, as the treatment of grades 1–3A principally is the same for stage III-IV, in both asymptomatic and symptomatic patients. In the last two cases, the difference in diagnosis (FL 3 vs. FL 3B) would result in the patient possibly not receiving the optimal therapy, as FL grade 3B is treated as a DLBCL. In situations dealing with FL grades 1–3A, one could argue that treatment of FL follows the same guidelines and this would suffice in daily clinical practice, however, FL can be heterogeneous and grade 3B or transformation to DLBCL can be found elsewhere in the remaining LN [20]. To this end, in clinical practice, a suspicion of high-grade lymphoma or transformation by PET-CT evaluation would result in the removal of a whole LN or a re-biopsy. We have included the three cases of different grades (grades 1 to 3 A) as correct. If these cases were to be defined as the diverging diagnosis, it would result in a sensitivity of CNB for diagnosing lymphoma of 59% (26/44 cases). In addition, suspicion of transformation to a large cell lymphoma from a low-grade lymphoma can be suspected from PET-CT imaging and clinical presentation. Partial involvement of a transformed lymphoma can be seen and a CNB might not be the correct approach in this scenario.